Breadcrumb

CCMS Forms Job Aid

The purpose of this job aid is to provide information on documents that can be generated using CCMS.

Note:If an * displays next to the Document Name, this means when this form is received into CCMS, the document type from the form is available on the Validate Documents page. If a ** displays next to the Document Name, this means when this form is received into CCMS, the document type, county, case name/number, and provider number/type from the form are available on the Validate Documents page.

Eligibility Function Documents:

Document Name

Generation Information

Available
in Spanish?

Mass Mailed?

What Triggers
Mass Mailing?

Work Item Information

IL444-3455
Child Care Application*

Generated when scanned or faxed to CCMS, fields automatically populate.

Yes

No

N/A

After you validate the application on the Validate Documents page,
an Application Work Item is created by CCMS.

IL444-3455E
Child Care Redetermination**

Generated by CCMS on the First Friday of every month and can also be generated by a user on demand using the Generate Documents page.

Yes

Yes

This form is created monthly on the First Friday of the month for every active case whose eligibility is ending not later than the end of next month.

To generate this form, you must be
in the context of
a case. A Redetermination Work Item is created when a Redetermination form is generated.

IL444-3455G
Request for a Child Care Provider
Change

Generated on demand by user, using the Generate Documents page.

Yes

Yes

User generates and submits the form using the Generate Documents page.

To generate this form, you must be in the context of a case. If not in the context of a Change of Information Work Item, manually create this Work Item and generate the form.

IL444-3527
Change of Information **

Generated on demand by user, using the Generate Documents page.

Yes

Yes

User generates and submits the form using the Genaerate Documents page.

A new COI Work Item is created when a COI form is generated.

IL444-4480
Request for Additional Information**

Generated on demand by user, using the Generate Documents page.

Yes

Yes

User generates and submits the form using the Genaerate Documents page.

To generate this form, you must be in the context of an Application, Rede, COI, or Provider Work Item AND a Case.

IL444-3514
(N-1-11) Wage Verification**

Generated on demand by user, using the Generate Documents page.

Yes

No

N/A

To generate this form, you must be in the context of a n Application, Rede, or COI Work Item AND a Case.

IL444-4339
Request for Provider Address Change

On demand by user, using the Generate Documents page.

Yes

No

N/A

To generate this form, you must be in the context of a provider. If you are not in the context of an Add/Update Provider Information Work Item, manually create this Work Item and generate the form.

IL444-3455A
(R-6-03) Approval of Request for Child Care Payments

Generated on demand by user, using the Generate Documents page.

Yes

Yes

User generates abd submits the form using the Generate Documents page.

To generate this form, you must be in the context of an Application Rede, or COI Work Item AND a case.

IL444-4178
(R-01-02) Notice of Cancellation of Child Care Payments

Generated by CCMS on First Friday of every month and can also be generated by a user on demand using the Generate Documents page.

Yes

Yes

This form is created monthly on the First Friday of the month for every active case whose eligibility is ending not later than the end of next month.

To generate this form, you must be in the context of Redetermination or COI Work Item AND a case.

IL444-4179
(N-9-98) Denial of Request for Child Care Payments

Generated by a user on demand using the Generate Documents page.

Yes

Yes

User generates and submits the form using the Generate Documents page

To generate this form, you must be in the context of an Application Work Item AND a Case.

IL444-4587
(N-01-01) Notice of Cancellation of Child Care Payments for Child Age 13

Generated by CCMS on First Friday of every month.

Yes

Yes

This form is created monthly on the First Friday of the month for every active case whose eligibility is ending not later than the end of next month.

To generate this form, you must be in the context of a Redetermination or COI Work Item AND a case.